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Details

Guardian Girls Karate Program

Friday 16, 23 & 30 October & 6 November from 10am-12pm

George Murray Building, City East Campus, Adelaide University

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Are you attending this event?

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Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Additional information

Age Group*

Student or Staff*

Adelaide University A Number*

Have you trained in martial arts of self-defence before?*

How did you hear about the course?*

How You Feel Right Now

The Guardian Girls Karate Program team would like to understand where you are starting from. There are no right or wrong answers to the following questions - just share how you honestly feel right now. Your responses are confidential and are used only for program evaluation. This form will be compared with your post-course evaluation to measure the impact of the program.

Please rate how you feel right now, before the course begins.

1 = Strongly Disagree, 5 = Strongly Agree

I feel confident I could protect myself if I needed to.*

I stay aware of what is going on around me when I am out.*

I trust my instincts when something does not feel right.*

I can set clear personal boundaries and hold them, even when it is hard.*

I can use my voice firmly and assertively if I feel unsafe.*

I can stay calm and think clearly under pressure.*

I know practical things I can do to help keep myself safe.*

I generally feel safe in my day-to-day life.*

I feel good about myself and my sense of self-worth.*

I believe every girl and woman should have access to these skills.*

I am interested in continuing karate or self-defence training.*

In your own words, what is your main reason for doing this course, and what do you hope to feel, know, or be able to do by the end?* Max 255 characters

Is there anything you feel nervous or uncertain about, or any injuries or physical considerations we should be aware of?* Max 255 characters

Your Previous Experiences

You do not need to share any details. This simply helps us to understand the experience level of our group.

Please let us know if any of the following are true:*

Yes - I have been in a situation where I felt physically unsafe

Yes - I have experienced harassment or threatening behaviour

I have not personally experienced this but it is a concern for me

I would prefer not to say

Consent

I understand that this baseline assessment will be compared with my post-course evaluation to measure the impact of the Guardian Girls Karate Program. I give permission for my anonymised responses to be used for program evaluation and improvement.

I agree to the above statement*

Yes

I am over 18, or, if I am under 18, this registration has been filled out by and endorsed by my parent or guardian.*

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